The Message Muddle on IUDs

Kate Klonick, writing for Slate, is the latest to champion the neglected IUD. She surveys the device’s troubled history to assess why it’s so obscure in this country and so popular elsewhere.

The IUD got a bad rap in the 1970s from the flawed and sometimes fatal Dalkon Shield. As Klonick points out, the memory of these dangerous IUDs in my mother’s generation yielded to lack of awareness in my generation, as American pharma companies forsook the IUD in all its forms by the 1980s. But the most interesting element of the IUD question, in my opinion, is the double-pronged nature of IUD ignorance. Lingering public misconceptions contribute to its lack of popularity, but these misconceptions are reinforced and even fueled by resistance from healthcare providers. Doctors and nurses are confused about IUDs, and they send confusing messages to us.

Some doctors don’t recommend IUDs to women who haven’t yet had children, and, as Klonick notes, one of the IUDs currently available, Mirena, is marketed to women who have children and don’t want any more. Klonick recalls her experience seeking an IUD:

Certain doctors who do know how to insert and remove an IUD still refuse to recommend it to childless patients because of the device’s checkered history. I experienced this with the first two doctors I visited. Though recent scholarship shows that the risk of an IUD creating infertility is almost nonexistent, some doctors prefer to insert them in patients already known to be fertile—so the IUD (and the doctor) can’t be blamed for any future infertility.

I, too, received mixed messages on Mirena when I was considering it this year. In a conversation with a nurse practitioner in her 40s, the RN pointed to the sample displayed prominently (next to a NuvaRing) a few feet from her chair. “I love this,” she said. “I’ve had three of them—I take it out when I want to get pregnant, and then I get another put in.” She even told me how easy my insertion would be, as she was staring into my cervix a few moments later.

A few months later I was still thinking about the IUD, and I called her practice to make another appointment. The nurse who answered the phone said, brusquely, “You’re considering Mirena? How old are you?” I’m 24. “Have you had children?” No. There was a long, damning silence at the other end. Then she put me through to the appointment line, where I was on hold. I hung up, chastised and newly doubtful.

This anonymous nurse’s pointed question was unexpectedly unsettling. When infertility is (supposedly) at stake, an implication—in a question or a tone of voice—is enough to scare someone off. The IUD looks good to me, but I’m not married to it if the medical community has serious and justified concerns. (I do suspect that some of these concerned doctors have some reading to catch up on.) In any event, it would be nice for women if doctors committed themselves to learning about IUDs so that we’re all on the same page.

I had an IUD in the 70’s and it was not a Dalkon Shield. It was a Lippes Loop. the 18 months I put up with that thing were some of the most miserable months of my life!!! I lost so much weight that I was down to 98 pounds toward the end of the time I had it. I would have 2 periods a month; one at the regular time and a smaller one at ovulation. My regular period was so heavy that I could not even leave home the first day because I had to change protection every 20 minutes. I had cramps that sometimes were as bad as the labor with my first and, at that time, only child and that labor lasted 52 hours! My skin broke out all the time and every time my husband and I had sex it hurt me. I finally had it taken out, even though my doctor told me that the IUD couldn’t possibly be causing all those problems. As soon as it was gone my problems disappeared, too, or so I thought. I went to a different gynecologist a couple of years later because I was having pain in my abdomen. Turns out that the string of the IUD had set up an inflammation of my cervix and I had to have my cervix frozen and deal with all that. Oh, I forgot the best part, before they decided the freezing would fix the problem they did a cervical biopsy, which was one of the most painful experiences of my life! Then, on the way home I began to hemorrhage and had to go back to have my cervic cauterized – even more painful!

They have come a long way I believe. My daughter has one now and has had no problems with it. Mine did not affect my fertility either, as, after they finally got all the problems with my cervix solved, I had another child.

invalid-0

I have an IUD right now – the Mirena. It was the best birth control decision I’ve made. I don’t think about it and don’t worry about it.

Having spoken to quite a few gynecologists about this issue, I think the reason they are hesitant to give IUDs to nulliparous women is simply that the uterus is smaller and (usually) the cervix has never been dilated. I had never given birth and the placement procedure was uncomfortable for me. So the only recommendation I would give about placement it make sure you have a few days to chill out and relax. The uterus (being the big old muscle that it is) gets a little freaked out when there is something put inside it. This just results in cramping, not unlike menstrual cramps.

Other than that, I think practitioners are hesitant to give them to younger women because they don’t protect against STIs. Generally, younger women tend to have more partners and doctors don’t want to be the cause of misinformation and therefore putting the woman at risk. And the solution to all that is making sure the woman getting the IUD has the right information.

I recommend it.

grayduck

Why waste time talking about IUDs when Implanon is available and more widely available?

I’m actually in the midst of submitting a paper to the Journal of Pediatric and Adolescent Gynecology on "Adolescents and IUDs – an under-utilized opportunity for pregnancy prevention."

The WHO Medical Eligibility criteria classify IUDs as Category 2 (the advantages generally outweigh risks) for women from menarche (the start of their periods) until 20 years of age.

I think Mirena is perfect for anyone who doesn’t want to get pregnant in the next 5 years. and what group is better suited to fit that, than a teen?

As for why not Implanon? Implanon works mainly through its hormonal action, so has systemic (all over your body effects) vs. Mirena which is more local (mainly its action is on the uterus). I am not sure of the side effects of Implanon (weight gain, bone density issues) vs. Mirena. But I am pretty sure that Mirena has less of those "systemic" side effects.

grayduck

"I think Mirena is perfect for anyone who doesn’t want to get pregnant in the next 5 years."

The people who make money every time someone chooses Mirena say the following. "Mirena offers a flexible option if you have had at least one child…" Until that changes, Implanon is the only good option for women and girls who have not given birth but may wish to do so in the future.

My bookmarks were apparently deleted during my recent computer upgrade, but my understanding is that Implanon has been shown not to reduce bone density. Its effects are apparently similar to oral contraceptives. Its effectiveness is superior to that of Mirena. Implanon is also a better option for those women who believe that life begins at fertilization and want to avoid methods that might cause a fertilized egg to implant.

Like New Zealand. I realise that the majority of people here are in the US, but there are contraceptive options available to you that aren’t available everywhere else.

Also, it’s possible to get a non-hormonal IUD, which is what I’m looking into. I get really bad reactions to contraceptive hormones, so I’m not keen on going back on Depo or the Pill. I can’t use the patch, Nuva-Ring’s not available here either (as far as I know). My mum had an IUD in the late 70s, she loved it. She had it removed and within a month was pregnant with me (first & only child).

frolicnaked

… but Implanon is not more widely available where I am.

Additionally, it’s at least as expensive as (if not more expensive than) both US IUD options, and lasts a maximum of 60% as long. (Implanon is good for 3 years. A Mirena IUD is approved for 5 years, and a ParaGard IUD is approved for 10 years.)

I’m glad you apparently really like Implanon — judging from your comment here and on this post –but it’s not the right option for everyone. And talking about other options is hardly "wasting time."